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Attachment II <br /> BENTLEY SELECT PROGRAM AGREEMENT <br /> AMERICAS <br /> SUBSCRIBER'S SITE INFORMATION <br /> Bentley SELECT Contract Number: . O0 cv <br /> Use this form to list all sites and all Bentley products at each site to be covered by the Bentley SELECT Agreement. <br /> Please complete a copy of this form for each site covered and insert into the Bentley SELECT Agreement. A "site" is defined as a <br /> geographic location or a department within your organization that operates and manages the group's CAD installation <br /> as a discrete functional unit. <br /> SITE INFORMATION: • <br /> Shipping Address: Billing Address 0fdfferent): <br /> C'any / � l 1477 <br /> Company Company <br /> • <br /> Site/Division <br /> SltelOtvisioh <br /> CR <br /> Manageme Contact Billing Contact `I)6 c& <br /> (',;Jur ���-er /�la� � <br /> Address/Street(no P.O.Box) flip a St 0 Address/Street(rho P.O.Box) <br /> 3c04,c // <br /> y City <br /> (1)4 ga--7vx <br /> ate Zip Country State Zip Country <br /> 7P/(I-6517_40 'hone Pa/Si-Coc17-COCay <br /> IN <br /> Phone Fax <br /> Designated <br /> T VAARR <br /> PRODUCT/PLATFORM INFORMATION: <br /> Please indicate quantity and platform of each product at the site above to be covered by Bentley SELECT Agreement. <br /> PRODUCT QUANTITY PLATFORM <br /> ✓Y1ir+6(3-f-fl(tn a7 r� <br /> • <br /> Primary Industry Code Application CAD Usage <br /> (Refer to the back of this page for industry and CAD usage codes,) <br /> DAA009610-1/0001 <br />